Do patients’ mood and gender affect the way we deliver CBT? An experimental, vignette-based study of the relevance of patient and clinician characteristics

Clinicians often fail to deliver the best psychological treatments available, especially if they perceive their patients as fragile or vulnerable. This fragility might be interpreted by clinicians through their internalised gender stereotypes (e.g. female patients are less resilient to a demanding treatment) or according to their patients' emotional state (e.g. the patient is too delicate to endure the most stress-inducing aspects of therapy). The aim of this study was to test experimentally whether patients’ characteristics influenced therapy delivery. Some clinician characteristics were also considered. This was an experimental, vignette-based study that evaluated clinicians' likelihood of utilizing several techniques commonly used in CBT by manipulating patients' mood and gender. Clinicians’ personality traits were also included as covariates. Anxious patients were the most likely to receive the techniques, especially exposure and other behavioural techniques. Therapists delivered more techniques to male patients, while angry and calm female patients were the least likely to receive the techniques. Therapists were more likely to deliver talking techniques to female patients. Clinicians’ firmness and empathy had an effect on CBT delivery. Future vignette-based studies should validate and pilot the vignettes. Technique clustering should also be based in factor analysis or similar methods. Direct observational methods might be more reliable than self-report. The findings suggest that clinicians treat their patients differently, either consciously or inadvertently. These differences are likely to be related to clinicians’ own concerns and gender stereotypes about their patients. •Therapists deliver a wider range of CBT techniques to male patients.•The use of exposure decreases with angry and female patients.•Therapists are more likely to deliver ‘talking’ techniques to female patients.•Clinicians' firmness and empathy influence technique use.•Clinicians are encouraged to be aware of their gender stereotypes and biases.